Acceptance and Commitment Therapy: End state functioning

1. Acceptance and Commitment Therapy: End state functioning Dr Matthew Smout Centre for Treatment of Anxiety and Depression South Australia

2. Aims • Overview how healthy ACT recipients are at the end of treatment • Put this in the context of end-state functioning typically achieved by other CBTs

3. Bench-marking Typical use: • Once efficacy established in tightly controlled RCTs • Evaluation of an EBT in “real-world” community setting (some inclusion criteria relaxed) • Model RCTs are selected either individually or aggregated to serve as benchmark • Comparison informal

4. Clinical significance • End-state functioning measured by clinical significance • Jacobson & Truax (1991) criteria: • > 2 SDs improvement on pre-test mean • < 2 SDs of functional population post-test • Post-test closer to functional than dysfunctional mean • Pre-determined reduction in Sx (e.g., 50%) • Composite or selection of outcome measures • Even large effect sizes are not necessarily clinically significant • 16/62 ACT RCTs included this information (Smout et al., 2012) • A further 3 ACT non-RCTs provided info (Scopus search on ACT in Title, 1/6/13).

5. “recovered” Non-clinical Error bars = 1 SD

7. OCD study sample characteristics

8. ACT studies CT CT CBT EX EX ACT ACT

9. ACT studies Social phobia study sample characteristics

10. Arch study: only 25% sample primary GAD • Error bars = SD

12. Demographics of ACT studies v CBT benchmarks depression

13. ACT studies Severe Recovered • CBT studies from Thoma et al (2012) meta-regression where trial quality score > 24 (55 Tx arms in 33 studies) • error bars: SEM

15. Efficacy > RCT benchmarks Aggregated benchmarks calculated by Minami et al (2007) NB: Below lower red dotted line: No better than natural remission

16. Efficacy > RCT benchmarks Aggregated benchmarks calculated by Minami et al (2007) NB: Below lower red dotted line: No better than natural remission

17. ACT studies

18. Demographics of ACT studies v CBT benchmarks pain ACT study

19. Demographics of ACT studies v CBT benchmarks pain ACT study

20. Demographics of ACT studies v CBT benchmarks pain ACT study

21. ACT studies: McCracken et al (2007); Vowles et al (2008) Other: 8 Tx groups from 4 studies (Leuw et al, 2008; Ersek et al., 2008; Smeets et al., 2008; Schmidt et al., 2011)

22. McCracken et al (2007); Vowles et al (2008); Johnston et al (2010)

23. ACT for psychosis in context

24. ACT studies Psychosis study sample characteristics

25. Error bars = SD

26. Psychosis study sample characteristics ACT studies

27. Error bars = SD

29. Conclusions • ACT for most conditions achieves outcomes within the range of average CBT studies (neither exceptionally better not worse) ?exception of social phobia • Larger samples of ACT participants would be needed to have more confidence in the point prevalence estimates • ACT researchers could contribute to efficient bench-marking through consistent reporting of essential demographic information.